Using a Decision Support Algorithm for Referrals to Post-Acute Care

Bowles, Kathryn; Ratcliffe, Sarah J.; Holmes, John H.; Keim, Sue; Potashnik, Sheryl; Flores, Emilia J.; Humbrecht, Diane; Whitehouse, Christina R.; Naylor, Mary D.

doi:10.1016/j.jamda.2018.08.016

Cited by 33 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings suggest that acute care providers might carefully consider which COVID-19 survivors would benefit from HHC after hospitalization. A decision support tool to identify general hospitalized patients for HHC referral may be helpful ( 31 , 32 ). Increasing referrals to HHC has the potential to provide support and achieve improved recovery for perhaps many more patients.…”

Section: Discussionmentioning

confidence: 99%

Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients

et al. 2021

Self Cite

View full text Add to dashboard Cite

Information does not yet exist on the characteristics and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) who are discharged to the home setting. Using rich data from home health care (HHC), the authors describe characteristics of COVID-19 survivors upon admission to HHC, the home visits they received, and the extent of recovery among those discharged from HHC. They also profile the risk factors associated with rehospitalization and death.

show abstract

Section: Discussionmentioning

confidence: 99%

Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Long-term Mortality and End-of-Life Care Among Medicare Sepsis Survivors postdischarge care decisions. For example, the optimal intensity and timing of postacute care services 39 and follow-up with primary care clinicians 40 for sepsis survivors is unknown.…”

Section: Jama Network Open | Critical Care Medicinementioning

confidence: 99%

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

et al. 2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population. OBJECTIVE To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care using national Medicare administrative, claims, and home health assessment data from 2013 to 2014. The initial and final primary analyses were conducted in July 2017 and from July to August 2019, respectively. EXPOSURES Sepsis hospital discharge and 1 or more home health assessments within 1 week. MAIN OUTCOMES AND MEASURES Outcomes were 1-year mortality among all sepsis survivors and hospitalization in the last 30 days of life, death in an acute care hospital, and hospice use among decedents. Multivariate logistic regression was used to identify factors associated with 1-year mortality and hospice use. RESULTS Among 87 581 sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care, 49 323 (56.3%) were aged 75 years or older, 69 499 (79.4%) were non-Hispanic white, and 48 472 (55.3%) were female. Among the total survivors, 24 423 (27.9%) people died within 1 year of discharge, with a median (interquartile range) survival time of 119 (51-220) days. Among these decedents, 16 684 (68.2%) were hospitalized in the last 30 days of life, 6560 (26.8%) died in an acute care hospital, and 12 573 (51.4%) were enrolled in hospice, with 5729 (45.6%) using hospice for 7 or fewer days. Several factors were associated with 1-year mortality, including a cancer diagnosis (odds ratio [OR], 3.66; 95% CI, 3.50-3.83; P < .001), multiple dependencies of activities of daily living or instrumental activities of daily living (OR, 2.80; 95% CI, 2.57-3.05; P < .001), and an overall poor health status (OR, 2.21; 95% CI, 2.01-2.44; P < .001) documented on home health assessment. Among the decedents, cancer was associated with hospice use (OR, 2.25; 95% CI, 2.11-2.41; P < .001), patients aged 85 years or older (OR, 1.49; 95% CI, 1.37-1.61; P < .001), and living in an assisted living setting (OR, 1.93; 95% CI, 1.69-2.19; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that death within 1 year after sepsis discharge may be common among Medicare beneficiaries discharged to home health care. Although 1 in 2 decedents used hospice, aggressive care near the end of life and late hospice referral were common. Readily identifiable risk factors suggest opportunities to target efforts to improve palliative and end-of-life care among high-risk sepsis survivors.

show abstract

“…Patients’ acceptance of home health care is associated with the quality of hospital discharge planning communication and prior positive or negative experiences with post-acute care [ 18 , 19 ]. Efforts to improve hospital discharge decision-making through clinical decision support may help to better align referral/receipt of services [ 8 , 20 ]. However, any efforts must also consider and address systemic barriers that contribute to ongoing racial/ethnic disparities in current home health care referrals and utilization patterns.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Smith

Jarrín

Lin

et al. 2021

IJERPH

View full text Add to dashboard Cite

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.

show abstract

Using a Decision Support Algorithm for Referrals to Post-Acute Care

Cited by 33 publications

References 17 publications

Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients

Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Contact Info

Product

Resources

About